Contract Details
Ancillary Care Services
Facility name
Lakewood Pathology Associates
Provider ID
P000003894
NPI
1134407646
Tax ID
223059768
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
9150 South Main Street Suite C
Houston, TX 77025
United States
County
Harris
Phone
8004407284 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address